I am lucky, I have just been for my annual mammogram and breast cancer check up and I have learned that I am still clear of this horrible disease. It is now 5 years since I was diagnosed and treated for breast cancer. 5 years clear: wonderful. However, that does not mean I am treatment free. I have been taking Letrozole for these first five years. The side effects of that drug are many and various. I think I suffered all of them, except high blood pressure! Anyway, the oncologist says it is time to move on from Letrozole to Tamoxifen.

Tamoxifen is another form of hormone treatment, known as endocrine therapy, for those who have had breast cancer. It is only prescribed if the breast cancer had receptors within the cell that bind it to oestrogen. All breast cancers are tested for oestrogen using tissue from a biopsy or after surgery. My tumour was found to be HER2+ and, as this can stimulate cancer tumours to grow, Tamoxifen is prescribed to help stop any cancer cells from growing.

If you are found to be hormone receptor negative, then Tamoxifen will not be of any benefit to you.

Primary breast cancer, which has not spread beyond the breast and lymph glands, may be treated with Tamoxifen after surgery. The lymph glands are under your arms. Tamoxifen is used as additional treatment to reduce the risk of the cancer returning and also to reduce the risk of new cancers developing. This is called adjuvant therapy.

Occasionally, Tamoxifen may be used as the first treatment for breast cancer. This may be when surgery is not appropriate or before surgery to shrink a large breast cancer tumour. Shrinking a large tumour in this way may mean that a mastectomy (breast removal) may be avoided and a lumpectomy (removal of the tumour and surrounding tissue) may be sufficient treatment. Also, Tamoxifen may be used for breast cancer that has returned into the breast or surrounding area. It can also be used if you are diagnosed with secondary breast cancer. This is when cancer cells from the breast have spread to other parts of the body.

In some instances, Tamoxifen may be an option for some people who have a high risk of developing breast cancer because of family history of the disease. This is in order to reduce the risk of development of breast cancer.

Tamoxifen is usually taken as a tablet, but may be prescribed as a liquid for those who find swallowing difficult. The recommended dose for the majority of people is 20mg. It is best to take one at the same time each day, but, if you miss a dose, it is not necessary to take an extra tablet because there will be a high enough level of the drug in your body from the previous day.

Usually, you will be prescibed Tamoxifen for a period of between 5 and 10 years. I have been told I should take the drug for a 5 year period. So, here goes, Tamoxifen here I come!

In the time when I am undergoing chemotherapy I am unable to go out as often as I would like and often cannot mix with friends so I spend much of my time reading and writing. Here I share some of my work and views with you.

SACRED HEARTS

1570 in the Italian city of Ferrara, and the convent of Santa Caterina is filled with noble women who are married to Christ because they cannot find husbands on the outside. Enter 16 year old Serafina, howling with rage and hormones and determined to escape. Her arrival disrupts the harmony and stability of the convent, as overseen by Madonna Chiara, an abbess as fluent in politics as she is in prayer. She assigns the novice into the care of Suora Zuana, the scholarly nun who runs the dispensary and treats all manner of sickness, from pestilence and melancholy to self-inflicted wounds. As an unlikely relationship builds between the two women, others figures stand watching and waiting; most notably theå novice mistress, Suora Umiliana, a crusader for God and ever stricter piety and the mysterious, decrepit Suora Magdalena, incarcerated in her cell with a history of ecstasy and visions.

This book is well researched and well crafted, and the descriptions are detailed. Perhaps too detailed to keep the work interesting. The author is keen for you too appreciate how clever she is and how much work she has put into her research. This gets old very fast. The story line is completely unbelievable and a very secondary part of the piece when compared to the description of life in a 16th Century convent so I cannot recommend this work.

Believe

Ultrasound then surgery

C T scan – lumpectomy

Felt great before they worked on me

Can you believe it?

To Glasgow for a hickman line

On good days, though I do feel fine

It hardly seems this life is mine

Can you believe it?

Coloured capsules: lots of pills

Hygiene, mouthwash ulcerous ills

Nosebleeds leaving bright red spills

Can you believe it?

Lethargy and long, long naps

Daytime TV: memory gaps

Sleepless nights spent reading pap

Can you believe it?

Urine dark as Grandpa’s tea

Baldy pate & sore left knee

The doctors say they’re curing me –

Can you believe it?

By Christmas time – I’m truly blessed

Accepting someone else knows best

Cured and healed with time for rest

You can believe it.

Valerie Penny

Virals

Tory Brennan, niece of acclaimed forensic anthropologist Temperance Brennan (of the Bones novels and hit TV show), is the leader of a ragtag band of teenage “sci-philes” who live on a secluded island off the coast of South Carolina. When the group rescues a dog caged for medical testing on a nearby island, they are exposed to an experimental strain of canine parvovirus that changes their lives forever.

As the friends discover their heightened senses and animal-quick reflexes, they must combine their scientific curiosity with their newfound physical gifts to solve a cold-case murder that has suddenly become very hot-if they can stay alive long enough to catch the killer’s scent.

Fortunately, they are now more than friends- they’re a pack. They are Virals. Unfortunately, this is a very poor book and not up to Kathy Reichs’ usual standards. It really disappointed me. The storyline is far-fetched, the characters not well drawn and I certainly cannot recommend this work.

I can only do what I have the energy to do from day to day. If that is reading writing and sharing my views, as I recover, so be it. Bear with me while I heal.

Some days are better than others. Wednesday 25 April was a busy day. I spent the first half of it shuffling from one doctor to another. My first appointment was at my GP just for a regular check-up. It was then I was able to tell my GP that I had been recalled after my mammogram. He was quite cross that the hospital had not informed him. The GP also wanted to speak to me about the length of time I had been taking hormone replacement therapy (HRT). It was a long time, over 12 years. However, in light of the other appointment I had to attend later in the morning he decided not to make any changes at this point.

When I came back out of the surgery, I phoned my husband and he drove me on to my next medical appointment of the day. This, again was a regular appointment. It was my fortnightly visit to my psychologist. It is, perhaps, also ironic that I did not believe in depression until I was diagnosed with it over 10 years ago. Like many people, I thought it was not truly an illness, but a state of mind that could be surmounted simply by “pulling yourself together”. I cannot help but think a higher being was having a laugh when they got their own back and I have battled depression, without surmounting it, for so many years now.

However, when the psychologist asked how I felt about the possibility of a diagnosis of cancer, I still could not truly admit that it might, even now happen to me. So I put on my mask, as I so often do when faced with a problem too difficult to face, and told her that I did not know how to feel, until I knew what I had to face. It sounds sensible, but really, I simply could not release my emotions or inhibitions: not then, not yet.

When my husband and I walked from the psychology department of the hospital to the breast cancer care department we went quite slowly. Almost as if by not knowing the results of the biopsy and screening it would prevent the news from being bad.

We were not kept waiting long before I was called through to meet with the doctor and my husband came with me. None of the staff that I had seen the previous week were at the clinic that day. It was a little daunting to know I was to get the results from someone I had never met before. However, the doctor introduced herself and the cancer nurse assigned to me was there and introduced herself too. She is Angela Watson.

It was explained to us that the biopsy had shown the tumour to be cancerous. It was explained to me that the disease had been found early and the tumour was about half the size of a baked bean. (I have always seen myself more as a “petit pois” kind of girl!) The doctor told me I would need to have surgery, a lumpectomy, (such an ugly word) to remove the tumour. I was given an appointment to meet with the surgeon on Friday and that I would probably go for surgery in 2-3 weeks. What a lot of information.

I was told the tumour was found to be HER-2 positive and that I should stop my HRT with immediate effect. HER2 is a protein found on the surface of certain cancer cells. Some breast cancers have a lot more HER2 receptors than others. In this case, the tumour is described as being HER2-positive. Tumours that are HER2-positive tend to grow more quickly than other types of breast cancer. Knowing if a cancer is HER2-positive can sometimes affect the choice of treatment. Women with HER2-positive breast cancer can benefit from a drug called trastuzumab (Herceptin). Herceptin only works in people who have high levels of the HER2 protein.

To understand HER2, it first helps to know a little about receptors and growth factors:

Receptors are particular proteins that are present within cells or on their surface. Other proteins or chemicals in the body can attach to these receptors to bring about change within a cell (for example, to make it reproduce or repair itself).

Growth factors are chemicals that attach to these receptors and stimulate cells to grow.

HER2 is a receptor found on the surface of certain cancer cells. It is made by a specific gene called the HER2/neu gene. HER2 is a receptor for a particular growth factor called human epidermal growth factor, which occurs naturally in the body. When human epidermal growth factor attaches itself to HER2 receptors on breast cancer cells, it can stimulate the cells to divide and grow.

Some breast cancer cells have a lot more HER2 receptors than others. In this case, the tumour is described as being HER2-positive. It is thought that about 1 in 5 women with breast cancer will have HER2 positive tumours. So roll on Friday and then I get to hear what the surgeon has to advise, but I am not ashamed to say, I have had better days.